Many workers and employers are still unaware of the Workers Compensation Independent Review Office (WIRO) and the role it can play in resolving workers compensation disputes with insurers. It is an independent statutory office, established in 2012 that functions as an ombudsman. Its role is to help resolve workers compensation disputes with insurers without resorting to adversarial processes.
Imagine a situation in which an employee is injured at work and makes a workers compensation claim which is in turn denied. Or perhaps an insurer conducts a review and determines that a worker is able to return to work at a time when the worker still feels unable to do so. What about an employer who is baffled by the calculation of workers compensation premiums? These are all issues with which WIRO may help (without litigation) and their assistance is free.
For the employee
Workers, particularly those suffering from an injury, can easily become frustrated when dealing with an insurance company. When a claim begins to go awry the delays, repeated inquiries and paperwork can become completely overwhelming.
WIRO may be a lifeline. The range of insurer-related issues with which WIRO can assist is basically as broad as human experience – denied claims, issues with payment of weekly benefits, medical treatment, denials of liability, delays in determining claims, reduced payments, Pre-Injury Average Weekly Earnings (PIAWE) that is too low, a work capacity decision that will result in a premature return to work, or inadequate reimbursements for travel costs to and from medical appointments.
It is important to remember that WIRO faces outward toward the insurer. If an employee has a separate dispute with his or her employer that dispute may not fall within WIRO’s mandate although it might be an issue with which outside counsel (see below) could assist.
For the employer
Employers are often the first resource to whom employees turn when difficulties with workers compensation arise. This can put an employer who would otherwise like to be helpful in an uncomfortable situation. A referral to WIRO may be the best solution in this situation.
Apart from that however, employers may find themselves with their own issues with workers compensation insurers. Among these may be:
- an action that has been taken, or not taken by the insurer in relation to workers compensation;
- the acceptance or denial of an employee’s workers compensation claim;
- acceptance of liability;
- the determination and calculation of workers compensation premiums; or
- claims management and handling.
What will WIRO do?
WIRO will work with you whether you are an employee or an employer by reviewing the relevant facts and circumstances, contacting the insurer on your behalf and generally encouraging you and the insurer to find a mutually acceptable solution. Their role is not to make a decision but to smooth the path toward one. Often the problem is that the issue has been misunderstood, or some paperwork is missing, not that there is a substantive dispute.
If you are an employee who has received a work capacity decision with which you disagree, WIRO can assist by providing information about the review process. WIRO can also assist injured workers to access free legal advice from a panel of approved experts. WIRO may also work with icare and SIRA to resolve an issue.
How to contact WIRO
An injured worker can make a complaint to WIRO by telephone on 13 9476, by using the online complaint form or emailing WIRO at [email protected].
Employers may contact WIRO at the same telephone number and then ask for the WIRO Solutions Group. Sometimes it is necessary to follow up with an email to the same address listed above.
The attorneys at Owen Hodge Lawyers would be happy to assist you with any workers compensation issues and to make the best possible use of WIRO processes and resources. Please call us to schedule a consultation at 1800 770 780.